Clinical history
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History of anemia due to oligo-ovulation and menorrhagia |
Morbid / severe central obesity |
Polycystic ovary syndrome1212 Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270-84. http://dx.doi.org/10.1038/nrendo.2018.24. PMid:29569621. http://dx.doi.org/10.1038/nrendo.2018.24...
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Hirsutism |
External
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Weight (BMI) |
227.2 kg, BMI: 86 kg/m2
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Class 3 obesity (Morbid/severe)33 National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 1998;6(Suppl. 2):51S-209S. PMid:9813653.,44 Medical Advisory Secretariat. Bariatric surgery: an evidence-based analysis. Ont Health Technol Assess Ser. 2005;5(1):1-148. PMid:23074460. |
Features of note |
Thick, dark hair especially on the neck (hirsutism), increased waist circumference and ratio of waist to hips (upper body obesity) |
Polycystic ovary syndrome, obesity and metabolic syndrome1212 Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270-84. http://dx.doi.org/10.1038/nrendo.2018.24. PMid:29569621. http://dx.doi.org/10.1038/nrendo.2018.24...
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Cardiovascular System
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Heart weight |
Cardiomegaly 730 g |
Heart failure1313 Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53(21):1925-32. http://dx.doi.org/10.1016/j.jacc.2008.12.068. PMid:19460605. http://dx.doi.org/10.1016/j.jacc.2008.12...
14 Alpert MA, Omran J, Bostick BP. Effects of obesity on cardiovascular hemodynamics, cardiac morphology, and ventricular function. Curr Obes Rep. 2016;5(4):424-34. http://dx.doi.org/10.1007/s13679-016-0235-6. PMid:27744513. http://dx.doi.org/10.1007/s13679-016-023...
15 Després JP, Carpentier AC, Tchernof A, Neeland IJ, Poirier P. Management of obesity in cardiovascular practice: JACC focus seminar. J Am Coll Cardiol. 2021;78(5):513-31. http://dx.doi.org/10.1016/j.jacc.2021.05.035. PMid:34325840. http://dx.doi.org/10.1016/j.jacc.2021.05...
16 Szczepaniak LS, Victor RG, Orci L, Unger RH. Forgotten but not gone: the rediscovery of fatty heart, the most common unrecognized disease in America. Circ Res. 2007;101(8):759-67. http://dx.doi.org/10.1161/CIRCRESAHA.107.160457. PMid:17932333. http://dx.doi.org/10.1161/CIRCRESAHA.107...
-1717 Ren J, Wu NN, Wang S, Sowers JR, Zhang Y. Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications. Physiol Rev. 2021;101(4):1745-807. http://dx.doi.org/10.1152/physrev.00030.2020. PMid:33949876. http://dx.doi.org/10.1152/physrev.00030....
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Heart chambers and walls |
Dilated and thickened left ventricle; Fibrosis of the right atrium and right papillary muscles |
Volume overload and pulmonary hypertension. |
Obesity-induced fibrosis. Obstructive sleep apnea1313 Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53(21):1925-32. http://dx.doi.org/10.1016/j.jacc.2008.12.068. PMid:19460605. http://dx.doi.org/10.1016/j.jacc.2008.12...
14 Alpert MA, Omran J, Bostick BP. Effects of obesity on cardiovascular hemodynamics, cardiac morphology, and ventricular function. Curr Obes Rep. 2016;5(4):424-34. http://dx.doi.org/10.1007/s13679-016-0235-6. PMid:27744513. http://dx.doi.org/10.1007/s13679-016-023...
15 Després JP, Carpentier AC, Tchernof A, Neeland IJ, Poirier P. Management of obesity in cardiovascular practice: JACC focus seminar. J Am Coll Cardiol. 2021;78(5):513-31. http://dx.doi.org/10.1016/j.jacc.2021.05.035. PMid:34325840. http://dx.doi.org/10.1016/j.jacc.2021.05...
16 Szczepaniak LS, Victor RG, Orci L, Unger RH. Forgotten but not gone: the rediscovery of fatty heart, the most common unrecognized disease in America. Circ Res. 2007;101(8):759-67. http://dx.doi.org/10.1161/CIRCRESAHA.107.160457. PMid:17932333. http://dx.doi.org/10.1161/CIRCRESAHA.107...
-1717 Ren J, Wu NN, Wang S, Sowers JR, Zhang Y. Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications. Physiol Rev. 2021;101(4):1745-807. http://dx.doi.org/10.1152/physrev.00030.2020. PMid:33949876. http://dx.doi.org/10.1152/physrev.00030....
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Obesity cardiomyopathy1717 Ren J, Wu NN, Wang S, Sowers JR, Zhang Y. Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications. Physiol Rev. 2021;101(4):1745-807. http://dx.doi.org/10.1152/physrev.00030.2020. PMid:33949876. http://dx.doi.org/10.1152/physrev.00030....
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Coronary arteries |
Patent |
Obesity paradox1818 Brodsky SV, Barth RF, Mo X, et al. An obesity paradox: an inverse correlation between body mass index and atherosclerosis of the aorta. Cardiovasc Pathol. 2016;25(6):515-20. http://dx.doi.org/10.1016/j.carpath.2016.09.002. PMid:27683962. http://dx.doi.org/10.1016/j.carpath.2016...
19 Barth RF, Maximilian Buja L, Cao L, Brodsky SV. An obesity paradox: increased body mass index is associated with decreased aortic atherosclerosis. Curr Hypertens Rep. 2017;19(7):55. http://dx.doi.org/10.1007/s11906-017-0753-y. PMid:28593612. http://dx.doi.org/10.1007/s11906-017-075...
20 Brodsky SV, Ganju R, Mishra S, et al. Genomic analysis of an obesity paradox: a microarray study of the aortas of morbidly obese decedents with mild and severe atherosclerosis. Crit Pathw Cardiol. 2019;18(1):57-60. http://dx.doi.org/10.1097/HPC.0000000000000169. PMid:30747767. http://dx.doi.org/10.1097/HPC.0000000000...
-2121 Qaisar S, Brodsky LD, Barth RF, et al. An unexpected paradox: wall shear stress in the aorta is less in patients with severe atherosclerosis regardless of obesity. Cardiovasc Pathol. 2021;51:107313. http://dx.doi.org/10.1016/j.carpath.2020.107313. PMid:33242600. http://dx.doi.org/10.1016/j.carpath.2020...
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Aorta |
Normal/without pathological alteration |
Obesity paradox1818 Brodsky SV, Barth RF, Mo X, et al. An obesity paradox: an inverse correlation between body mass index and atherosclerosis of the aorta. Cardiovasc Pathol. 2016;25(6):515-20. http://dx.doi.org/10.1016/j.carpath.2016.09.002. PMid:27683962. http://dx.doi.org/10.1016/j.carpath.2016...
19 Barth RF, Maximilian Buja L, Cao L, Brodsky SV. An obesity paradox: increased body mass index is associated with decreased aortic atherosclerosis. Curr Hypertens Rep. 2017;19(7):55. http://dx.doi.org/10.1007/s11906-017-0753-y. PMid:28593612. http://dx.doi.org/10.1007/s11906-017-075...
20 Brodsky SV, Ganju R, Mishra S, et al. Genomic analysis of an obesity paradox: a microarray study of the aortas of morbidly obese decedents with mild and severe atherosclerosis. Crit Pathw Cardiol. 2019;18(1):57-60. http://dx.doi.org/10.1097/HPC.0000000000000169. PMid:30747767. http://dx.doi.org/10.1097/HPC.0000000000...
-2121 Qaisar S, Brodsky LD, Barth RF, et al. An unexpected paradox: wall shear stress in the aorta is less in patients with severe atherosclerosis regardless of obesity. Cardiovasc Pathol. 2021;51:107313. http://dx.doi.org/10.1016/j.carpath.2020.107313. PMid:33242600. http://dx.doi.org/10.1016/j.carpath.2020...
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Respiratory System
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Lung weight |
Weight increased; L 1100 g, R 1200 g** |
Pulmonary edema |
Vasculature |
Microscopically: thromboembolic lesions in the small & intermediate pulmonary vessels |
Acute phase of thromboembolic disease2222 Wagenvoort CA. Pathology of pulmonary thromboembolism. Chest. 1995;107(1, Suppl.):10S-7S. http://dx.doi.org/10.1378/chest.107.1_Supplement.10S. PMid:7813322. http://dx.doi.org/10.1378/chest.107.1_Su...
23 Marongiu F, Mameli A, Grandone E, Barcellona D. Pulmonary thrombosis: a clinical pathological entity distinct from pulmonary embolism? Semin Thromb Hemost. 2019;45(8):778-83. http://dx.doi.org/10.1055/s-0039-1696942. PMid:31537029. http://dx.doi.org/10.1055/s-0039-1696942...
24 Cao Y, Geng C, Li Y, Zhang Y. In situ pulmonary artery thrombosis: a previously overlooked disease. Front Pharmacol. 2021;12:671589. http://dx.doi.org/10.3389/fphar.2021.671589. PMid:34305592. http://dx.doi.org/10.3389/fphar.2021.671...
25 Lucena J, Rico A, Vázquez R, et al. Pulmonary embolism and sudden-unexpected death: prospective study on 2477 forensic autopsies performed at the Institute of Legal Medicine in Seville. J Forensic Leg Med. 2009;16(4):196-201. http://dx.doi.org/10.1016/j.jflm.2008.08.015. PMid:19329075. http://dx.doi.org/10.1016/j.jflm.2008.08...
26 Mullin CJ, Klinger JR. Chronic thromboembolic pulmonary hypertension. Heart Fail Clin. 2018;14(3):339-51. http://dx.doi.org/10.1016/j.hfc.2018.02.009. PMid:29966632. http://dx.doi.org/10.1016/j.hfc.2018.02....
27 Matthews DT, Hemnes AR. Current concepts in the pathogenesis of chronic thromboembolic pulmonary hypertension. Pulm Circ. 2016;6(2):145-54. http://dx.doi.org/10.1086/686011. PMid:27252839. http://dx.doi.org/10.1086/686011...
-2828 Piazza G, Goldhaber SZ. Chronic thromboembolic pulmonary hypertension. N Engl J Med. 2011;364(4):351-60. http://dx.doi.org/10.1056/NEJMra0910203. PMid:21268727. http://dx.doi.org/10.1056/NEJMra0910203...
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Hepatobiliary System
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Liver weight |
Hepatomegaly; 2300 g** |
Congestive heart failure |
Liver microscopic findings |
Fatty liver with low grade fibrosis of the portal triad |
Nonalcoholic fatty liver disease (NAFLD) and Metabolic syndrome1010 Pafili K, Roden M. Nonalcoholic fatty liver disease (NAFLD) from pathogenesis to treatment concepts in humans. Mol Metab. 2021;50:101122. http://dx.doi.org/10.1016/j.molmet.2020.101122. PMid:33220492. http://dx.doi.org/10.1016/j.molmet.2020....
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Gall Bladder |
Gallstones |
Cholelithiasis due to obesity88 Segula D. Complications of obesity in adults: a short review of the literature. Malawi Med J. 2014;26(1):20-4. PMid:24959321. |
Genitourinary System
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Kidney weights |
Weight increased; L 210 g |
Consistent with hyperfiltration due to obesity99 Tsuboi N, Okabayashi Y, Shimizu A, Yokoo T. The renal pathology of obesity. Kidney Int Rep. 2017;2(2):251-60. http://dx.doi.org/10.1016/j.ekir.2017.01.007. PMid:29142961. http://dx.doi.org/10.1016/j.ekir.2017.01...
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R 210 g. |
Increased glomerular size |
Reticuloendothelial System
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Spleen weight |
Splenomegaly; 450 g** |
Early portal hypertension or right-side heart failure, or increased growth factor due to obesity1111 Tarantino G, Citro V, Conforti P, Balsano C, Capone D. Is there a link between basal metabolic rate, spleen volume and hepatic growth factor levels in patients with obesity-related NAFLD? J Clin Med. 2019;8(10):1510. http://dx.doi.org/10.3390/jcm8101510. PMid:31547124. http://dx.doi.org/10.3390/jcm8101510...
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Endocrine System
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Body fat |
Increased body fat and obesity |
Leptin resistance, insulin resistance88 Segula D. Complications of obesity in adults: a short review of the literature. Malawi Med J. 2014;26(1):20-4. PMid:24959321.,99 Tsuboi N, Okabayashi Y, Shimizu A, Yokoo T. The renal pathology of obesity. Kidney Int Rep. 2017;2(2):251-60. http://dx.doi.org/10.1016/j.ekir.2017.01.007. PMid:29142961. http://dx.doi.org/10.1016/j.ekir.2017.01...
and polycystic ovary syndrome1212 Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270-84. http://dx.doi.org/10.1038/nrendo.2018.24. PMid:29569621. http://dx.doi.org/10.1038/nrendo.2018.24...
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Central Nervous System
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No pathological alteration |
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Reproductive
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Uterus |
Endometrial polyp |
Polycystic ovary syndrome1212 Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270-84. http://dx.doi.org/10.1038/nrendo.2018.24. PMid:29569621. http://dx.doi.org/10.1038/nrendo.2018.24...
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Ovaries |
Multiple cysts on both ovaries |
Polycystic ovary syndrome1212 Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270-84. http://dx.doi.org/10.1038/nrendo.2018.24. PMid:29569621. http://dx.doi.org/10.1038/nrendo.2018.24...
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